Abstract
Objective
Public and private mental health-funded services differ in terms of accessibility, affordability, and perceived quality, potentially impacting outcomes. Understanding how different mental health service types and sociodemographic factors correlate with depressive symptoms is critical for informing equitable mental health policies and resource allocation. This study investigates the associations between type of mental health service used and depressive symptoms.
Method
Data from Mental Health Research Canada's National Poll Understanding the Mental Health of Canadians 2022 to 2024 was analyzed. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Mental health-funded services were classified as public or private. Linear and logistic regressions examined associations with depressive symptom severity (total PHQ-9 scores) and presence of depressive symptoms (PHQ-9 score
Results
The study included 2,072 adults, with 1,000 (47.4%) reporting depressive symptoms. Compared to public services, individuals using private services (n = 880, 41.8%) had lower PHQ-9 scores (aCoef: −1.34, 95% CI [−1.97, −0.70]; p < .001) and lower odds of having depressive symptoms (aOR: 0.74, 95% CI [0.60, 0.91]; p = .004). Household income partially mediated the relationship between funded service type and PHQ-9 scores, accounting for 39.5% of the effect (p < .001), and fully mediated the relationship with the presence of depressive symptoms, with a mediation effect of 40.6%. Additionally, individuals who attended services monthly, weekly, or more frequently had higher odds of having depressive symptoms (aOR: 2.86, 95% CI [1.23, 6.68]; p = .015).
Conclusion
This study highlights the complex interplay between mental health service types used, sociodemographic factors, and mental health outcomes. These insights underscore the need to address barriers to effective mental health care access and tailor interventions to individuals’ socioeconomic and demographic contexts to optimize outcomes.
Plain Language Summary Title
How Public and Private Mental Health Services Relate to Depression in Canada
Plain Language Summary
Access to mental health care in Canada varies depending on whether someone uses public or private services. These differences may affect how people experience and manage depression. This study looked at over 2,000 adults across Canada to see how the type of mental health care they used-public or private-was related to their symptoms of depression. Depressive symptoms were measured using a standard questionnaire. The study found that people who used private mental health services had fewer symptoms of depression and were less likely to meet the criteria for moderate-to-severe depression, compared to those using public services. One possible reason for this difference is income. People with higher incomes were more likely to use private services, and income appeared to explain part of the link between service type and depression levels. The study also found that people who went to mental health services more frequently-weekly or monthly-tended to report more symptoms of depression. This may be because individuals with more severe symptoms need more frequent support. Overall, the findings show that how and where people access mental health care matters, and that income plays a big role. These results suggest the need for policies that make high-quality care more accessible to everyone, regardless of their financial situation, to improve mental health outcomes across the population.
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